Clinical Features, Endoscopic Findings and Mortality of Upper Non-Variceal Gastrointestinal Bleeding in Patients with Cirrhosis

Abstract

Purpose: To describe the clinical characteristics, endoscopic findings, treatment and mortality in patients with cirrhosis and non-variceal upper gastrointestinal bleeding (NVUGB). Methods: From a previously collected database (2000 to 2009) we identified all patients admitted to the hospital with NVUGB. All patients with confirmed diagnosis of cirrhosis as well as those found to have liver disease were included in the analysis. We studied demographic data, clinical features, endoscopic findings and treatment, length of hospital stay, complications and mortality. Variables were expressed as mean and standard deviation. Descriptive statistics expressed as mean, standard deviation and frequencies were used to describe findings. Results: Of 1067 patients with NVUGB, we found 15% (n=160) with diagnosis of cirrhosis; mean age of 56.5±14.4 and male predominance (77.2%, n=124). Alcohol induced liver disease was found in 63.1% (n=101). Child-Pugh B status was most frequently encountered (38.1%, n=61). Of major comorbidities, DM2 was found as the most frequent (21.3%, n=34), with a mean number of comorbidities of 1.6±0.8. Melena was the most frequent clinical finding (68.8%, n=110), and hemodynamic instability was found in 29.4% (n=47). Mean hemoglobin level at admission was 9.5±3.3, and transfusion was required in 59.4% (n=95), with 3.1±2 mean blood units transfused. Endoscopy was performed promptly (≤24hrs) in 73.1% (n=117). Gastric ulcer was the most frequent cause of bleeding (24.4%, n=39), followed by duodenal ulcers (20.6%, n=33) and congestive gastropathy (18.1%, n=29). High-risk ulcers were found in 53.1% (n=43). Endoscopic treatment was used in 36.3%, (n=58). Combined endoscopic treatment was used in 55.1% (n=32). Hospital stay was 5.8±3.6 days. Mortality occurred in 13.8% (n=22) most deaths were not related to hypovolemia (31.8%, n=7). Conclusion: Patients with cirrhosis and NVUGB presented with severe bleeding and most deaths are not related to hypovolemia.